A Texas newspaper's review of documents related to about three-dozen deaths at state-run mental health hospitals between 2005 and 2012 raises the question about the need for more oversight.

The Austin American-Statesman reported Sunday that patient deaths are usually reviewed by the hospital where they died as well as the Texas Department of State Health Services.

Agency spokeswoman Carrie Williams said the agency welcomes additional scrutiny and feedback to improve the lives of patients.

"Our doors are wide open," she told the newspaper.

An expert hired by the American-Statesman to review government and other public database documents said there are systemic problems in the state's investigations. The newspaper obtained more than three dozen reports and reviewed 34 of them. When the agency was asked for more documents, it said it had been a mistake to release the previous ones and declined to provide more.

Dr. Sidney Weissman, a psychiatrist and professor at Northwestern University's Feinberg School of Medicine, said the number of deaths didn't seem excessive, but he noted lapses in leadership, flaws in care and a reluctance to take responsibility for shortcomings.

"There's an attempt to attribute deaths to medical illnesses, not medical care," Weissman said.

In a 2011 death review at Rusk State Hospital, Weissman found that doctors appeared to have missed signs of worsening congestive heart failure. The committee that conducted the administrative death review noted that the hospital didn't have a protocol for monitoring symptoms of congestive heart failure "but should (consider) developing such protocol."

However, that committee ruled that there were no problems in medical care.

"This is a total breakdown in the care of this patient, and nobody wants to say it's a serious breakdown," Weissman said. "There's always an explanation. There's always an excuse."

Outside agencies like Medicare, the Health and Human Services Office of the Inspector General and the Texas Medical Board may review deaths in Texas' hospitals. In cases when those agencies have gotten involved, they found problems, the newspaper found.

Medicare examined two of the cases reviewed by the newspaper and the Inspector General's office looked into three. The Texas Medical Board does not disclose that information.